“The worst is behind for Kerala,” says one of India’s foremost health economists, who has closely tracked Kerala’s COVID-19 situation since the start of the pandemic.
Professor Rijo M. John said that in the last three weeks, hospital admissions have declined by 24%, ICU and ventilator requirements by 7% and oxygen requirement by 10%. The Institute of Mathematical Sciences in Chennai reported the ‘R number’ has fallen below 1.
The R number is a measure that highlights the number of people a person infected with the coronavirus can pass the virus on to, thereby reflecting the severity of its spread. A number of one or below one indicates a slowly spreading virus, while any number above one indicates a rapid spread.
However, he expressed serious concern about the 30% decline in testing since Kerala reached its peak on August 30 and called upon the government to rethink and reconsider its emphasis on home isolation which, he believes, is an important factor behind the persistently high test positivity rate of around 15%. Up to 80% of Kerala’s COVID-19 patients are kept in home isolation.
In an interview with Karan Thapar for The Wire, John, who is adjunct professor at the Rajagiri College of Social Sciences in Kochi, said the 36% decline in cases since August 30 is only “partly genuine”. At their peak, in mid-August, testing levels averaged just under 2 lakh a day but now average around 1 or 1.05 lakh a day.
Also read: Why Kerala’s Response to COVID-19 Has Positive Lessons for India
He said, “The Centre is right to be concerned about Kerala’s test positivity rate (TPR) which is high and has been high for quite a while.” He told The Wire that since August 30, the TPR has declined by 15% but it’s still at 15-15.5% levels.
He identified three critical reasons why Kerala’s TPR remains stubbornly high. The first, he said, is the 30% reduction in testing since August 30 or the almost 50% reduction from the peak testing levels of mid-August. As you lower testing you inevitably push up the positivity rate.
The second reason, he said, is the change in the mix between RT-PCR and antigen testing in the overall testing done in Kerala. In mid-August, 55% of Kerala’s tests were RT-PCR and 45% were antigen. Now, 70% of Kerala’s tests are RT-PCR and only 30% are antigen. RT-PCR tests are far more accurate and provide more positive results. Antigen tests, on the other hand, throw up 50% false negatives. This change in the balance of testing has also thrown up high levels of positivity.
In fact, in six districts of Kerala, although only in government hospitals, only RT-PCR testing is done.
However, the third reason, he further said, is that Kerala follows a policy of keeping up to 80% of COVID-19 patients in home isolation. As he pointed out, the secondary strike rate of the Delta variant (i.e. the rate at which other people in the same house are affected) is very high, and this policy of home isolation means that infection spreads faster and further, thus driving up the TPR.
He called upon the Kerala government to both increase testing and take it back to the near 2-lakh levels of mid-August and also to rethink its emphasis and stress on home isolation for COVID-19 patients.
However, he did not agree with the director of the National Centre for Disease Control, Dr Sujeet Kumar Singh, that Kerala’s high TPR suggests COVID-19 appropriate behaviour is not being properly observed.
Speaking about a concern expressed by Singh six weeks ago, after he returned from Kerala as the head of a team sent by the Union government, that pressure in hospitals in the northern districts of the state is worrying and that in Malappuram, in particular, hospitals were 90% full, professor John said: “The situation has changed significantly and improved vastly.”
He said both the incidence of serious illness and the consequent pressure on hospitals is markedly down and no longer a problem for the healthcare system of the state.
